Once upon a time, the only choice for turning back the clock was a nip and tuck. Surgery was our only option. These days the possibilities seem endless, making it difficult to know what to do, where to go and who to trust, especially since techniques and technology are changing fast.
From lasers and microneedling to injectables and red-light therapy, the boundaries of cosmetic procedures stretch with every scientific innovation. Recently we talked to three of Baltimore’s top plastic surgeons about the latest treatments.
All three doctors agree on a few issues: The earlier the better for surgery and topical procedures. And, extreme is out. Subtle is in. Women — and men — want to look rejuvenated, not different. The goal is to look like yourself, only better. And, before signing up for the newest treatment touted on the latest podcast, it’s best to wait until the “newest” is a proven product.
Theda Kontis, M.D., FACS
Facial Plastic Surgeon, Aesthetic Center at Woodholme
“The latest change is young people want to have a lot done and it’s all driven by social media,” says Dr. Kontis. “Women in their 40s and 50s rather than 60s or 70s are having facelifts and want injectables in their 20s and 30s rather than in their 40s or 50s. If you asked me 20 years ago about using injectables at a young age, I’d say it is a terrible idea. From what I’ve seen after many years, injectables slow down the aging process. Over time they help with wrinkles and volume. Doing injectables earlier makes sense.”
She says postponing a facelift too long isn’t a great idea. “If you wait until you are 60 or 70, there are health issues to consider. Patients must get medical approval for surgery. Some may be on blood thinners, which can cause problems.”
As for all the other topical treatments, Dr. Kontis says, “Radio frequency microneedling is like aerating your lawn and stimulates collagen.”
“We do a lot of PRP (platelet-rich plasma) for hair growth. It is phenomenal how well it works,” says Dr. Kontis. PRP uses a patient’s own blood to stimulate tissue regeneration and improve the appearance of the skin. “I was doing PRP on an older lady for her hair — it was white and it started to grow back thicker and in her natural color. It was unbelievable!” she adds.
“SKINVIVE is a new injectable and while I haven’t used it on many people, the results are amazing,” says Dr. Kontis. The treatment involves a lot of little very superficial injections that hydrates the skin. “We did clinical trials on it and there was definitely an increase in skin hydration because it plumps the skin up and fine wrinkles get better.”
Adam L. Basner, M.D.
Plastic Surgery
“There are always new nonsurgical things on the market,” says Dr. Basner. “It is important for people to understand that any nonsurgical result will in no way compare to surgical result. You are not going to come in and have something done, go home with little or no recovery, and get anything that compares to what is achievable with surgery. There is a belief that you can do something with minimal downtime and recovery time and expect great things. You can’t. That doesn’t mean there aren’t effective nonsurgical, noninvasion options to address fine lines and skin rejuvenation,” Dr. Basner adds.
Sofwave is one option. This focused ultrasound is applied to the skin and the ultrasound energy penetrates down to the deeper layers of the skin resulting in collagen remodeling and beneficial tightening effects. Sofwave has no downtime. “You come in, you get numb, you have the treatment and you walk out. No one knows you did anything. You literally go back to work,” adds Dr. Basner.
Chemical peels are effective, but they are usually done in conjunction with surgery because of the recovery time. “If you are having surgery and taking time off to recover, it makes sense to get the peel,” he adds.
According to Dr. Basner, all of the noninvasive treatments are somewhat similar since they are all trying to cause collagen to remodel — whether it be radio frequency, microneedling, Sofwave, chemical peels, or dermabrasion. They are all trying to accomplish the same thing.
Craig Vander Kolk, M.D.
Director of Cosmetic Medicine and Surgery at Mercy Medical Center
“For total care, the ideal situation is to create a plan with a surgeon you trust along with a good medi-spa. That way your surgical plan works in tandem with injectables and other topical treatments to help you achieve your goals,” says Dr. Vander Kolk. “Analysis and understanding of where we want to go is critical to making the right decisions. Surgery provides predictable, good result. Can nonsurgical procedures do it as well as surgery? Probably not, but it can definitely help freshen the skin.”
“The field of anti-aging is doing a lot,” says Dr. Vander Kolk. “Exosomes is an area that is going to get better and better. Exosomes are derived from stem cells from donated tissues — adipose, bone marrow and placental, which makes the procedure quicker, simpler, and more accessible.”
Exosomes are described as a little care package for the cells to communicate with each other. They are packed with lipids, proteins and nucleic acids. When injected or used topically, exosomes might help skin not only look better but also behave like younger skin on a deep cellular level.
As we age, we lose volume and fillers work great for loss of volume. “I personally think fat is better but the goal is to fill that loss of volume. The loss of volume and collagen is what creates fine lines and wrinkles,” he adds.
“Fat transfers last longer than other fillers and anything that uses your own tissue is great. With fat you get the volume all at once but not all the fat survives. People thought it lasted forever. I think it lasts probably three to five years as opposed to months like fillers,” says Dr. Vander Kolk. Fat brings stem cells with it, usually resulting in skin improvement as well as volume.
Dr. Vander Kolk likes SKINVIVE by JUVÉDERM, a newer filler that plumps the skin, making it look less thin. He also likes Sculptra. “This filler has been around for a while and it works well for stimulating collagen,” he adds.
As for red-light therapy, “I try to stay with scientific things; I haven’t seen good papers on it,” says Vander Kolk. He says with any of these new treatments, you need to balance the results with the costs.
“Right now, the only scientific and proven thing that works is Retin-A. It is still the key to making skin healthier,” says Dr. Vander Kolk.
